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PubMed2003

Management of urinary extravasation in 18 boys with posterior urethral valves.

PURPOSE: Urinary extravasation with associated posterior urethral valves is uncommon and published articles are restricted to case reports. We propose a management algorithm on the basis of presentation of 18 boys with this condition. MATERIALS AND METHODS: In this retrospective review we analyze the clinical features, diagnostic radiological imaging (voiding cystourethrogram and (99m)technetium mercaptoacetyltriglycine scan) and measured glomerular filtration rate (GFR) for assessment of renal function in boys presenting with posterior urethral valves and urinary extravasation. Indications for surgical intervention and long-term outcome were evaluated. Results are presented as mean +/- SD. RESULTS: Patient age at presentation was 4 days (range 1 to 28). Salient features at presentation were abdominal distention in 55.5% of cases, flank mass in 55.5%, respiratory distress in 16.6% and septicemia in 22.2%. Patients were categorized into group 1 with ascites (6 boys) and group 2 without ascites (12). Followup was 70.8 +/- 5.6 months. In group 1 the 3 boys with ascites alone had a followup GFR of 29 versus 74 ml. per minute per 1.73 m.2 in 3 with urinoma plus ascites (p = 0.001) at 64 +/- 4.9 months. In group 2 the GFR in 3 boys with bilateral urinoma was 104.7 +/- 30.4 versus 54.3 +/- 29.4 ml. per minute per 1.73 m.2 in the other 9 with unilateral urinoma (p = 0.001) at 36 +/- 4.2 and 81.3 +/- 4.7 months, respectively. The ipsilateral kidney showed reduced function in 6 of 12 boys with unilateral urinoma from both groups. CONCLUSIONS: Renal function on the side of the urinoma is impaired, and the majority of patients have impaired global renal function. A management algorithm is proposed.

Algorithms↗

PubMed1980

Effects of ventricular pacing on regional left ventricular performance in the dog.

Changes in regional left ventricular (LV) performance induced by ventricular pacing were studied in two groups of open-chest anesthetized dogs. In the first group of five dogs, local function at the LV anterior base, anterior apex, and posterior apex was assessed by ultrasonic crystal pairs with atrial, right ventricular, LV apical, and LV base pacing. Ventricular pacing produced asynchrony of contraction and marked changes in the shortening pattern at each site, as well as an average 27% reduction in peak systolic pressure and peak dP/dt compared to atrial pacing. Moreover, the extent of shortening during LV ejection was reduced or unchanged at all sites measured during ventricular pacing. In the second group of five dogs, function of the septum and opposing LV lateral wall was studied with atrial and LV lateral wall pacing. Lateral function was assessed with a crystal pair and septal function by cineradiography of a lead bead implanted in the septum. Ventricular pacing produced reciprocal interaction between the two walls, with early lateral shortening inducing septal bulging and late septal shortening inducing lateral wall systolic lengthening. We conclude that ventricular pacing produces significant changes in regional myocardial function, likely induced by reciprocal interaction of opposing myocardial regions. Furthermore, such interaction appears deleterious to global ventricular function, presumably because volume is sequestered and pressure is dissipated into relatively inactive segments that are out of phase with the bulk of contracting myocardium.

Animals↗

PubMed1998

Development of a patient-reported measure of function of the knee.

The purpose of the present study was to demonstrate the reliability, validity, and responsiveness of the Activities of Daily Living Scale of the Knee Outcome Survey, a patient-reported measure of functional limitations imposed by pathological disorders and impairments of the knee during activities of daily living. The study comprised 397 patients; 213 were male, 156 were female, and the gender was not recorded for the remaining twenty-eight. The mean age of the patients was 33.3 years (range, twelve to seventy-six years). The patients were referred to physical therapy because of a wide variety of disorders of the knee, including ligamentous and meniscal injuries, patellofemoral pain, and osteoarthrosis. The Activities of Daily Living Scale was administered four times during an eight-week period: at the time of the initial evaluation and after one, four, and eight weeks of therapy. Concurrent measures of function included the Lysholm Knee Scale and several global measures of function. The subjects also provided an assessment of the change in function, with responses ranging from greatly worse to greatly better, at one, four, and eight weeks. The Activities of Daily Living Scale was administered to an additional sample of fifty-two patients (thirty-two male and twenty female patients with a mean age of 31.6 years [range, fourteen to sixty-six years]) before and after treatment within a single day to establish test-retest reliability. Factor analysis revealed two dominant factors: one that reflected a combination of symptoms and functional limitations and the other, only symptoms. The internal consistency of the Activities of Daily Living Scale was substantially higher than that of the Lysholm Knee Scale (coefficient alpha, 0.92 to 0.93 compared with 0.60 to 0.73), resulting in a smaller standard error of measurement for the former scale. Validity was demonstrated by moderately strong correlations with concurrent measures of function, including the Lysholm Knee Scale (r = 0.78 to 0.86) and the global assessment of function as measured on a scale ranging from 0 to 100 points (r = 0.66 to 0.75). Analysis of variance with repeated measures revealed significant improvements in the score on the Activities of Daily Living Scale during the eight weeks of physical therapy (F2,236 = 108.13; p < 0.0001); post hoc testing indicated that the change in the score at eight weeks was significantly greater than the change at four weeks and that the change at four weeks was significantly greater than that at one week (p < 0.0001 for both). As had been hypothesized, the patients in whom the knee had somewhat improved had a significantly smaller change in the score, both at four weeks (F1,189 = 33.50; p < 0.001) and at eight weeks (F1,156 = 22.48; p < 0.001), compared with those in whom the knee had greatly improved. The test-retest reliability coefficient (intraclass correlation coefficient[2,1]) was 0.97. These results suggest that the Activities of Daily Living Scale is a reliable, valid, and responsive instrument for the assessment of functional limitations that result from a wide variety of pathological disorders and impairments of the knee.

Activities of Daily Living↗

PubMed2004

Ischemic cardiomyopathy: value of different MRI techniques for prediction of functional recovery after revascularization.

OBJECTIVE: The purpose of this study was to compare the value of different MRI techniques for the assessment of myocardial viability. SUBJECTS AND METHODS. Eighteen infarct patients (mean age +/- SD, 62 +/- 8 years) with myocardial ischemia were examined using MRI before and after revascularization. The MRI study before treatment consisted of an evaluation of first-pass perfusion, contractile function at rest and during dobutamine stress, and delayed hyperenhancement. Findings were correlated with segmental and global cardiac function after revascularization. RESULTS: In initially dysfunctional segments, the likelihood of functional recovery after revascularization was 91% for segments without delayed hyperenhancement, 43% for segments with delayed hyperenhancement with transmural extent of 75% or less, and 8% for segments with delayed hyperenhancement with transmural extent of more than 75% (p < 0.05). Improved function at dobutamine stress MRI indicated functional recovery in 87%, whereas functional recovery was observed in only 30% of segments not responding at dobutamine stress MRI (p < 0.05). No significant correlation was found between the results of first-pass perfusion MRI and functional recovery. The ejection fraction after revascularization was best predicted by the MRI-derived infarct volume (p < 0.001, R(2) = 0.63). CONCLUSION: A simple protocol consisting of baseline contractility and delayed enhancement MRI studies is adequate to differentiate dysfunctional but viable from nonviable myocardium. Dobutamine stress and perfusion MRI studies offer little or no additional information.

Aged↗

PubMedDate not supplied

[Ventricular diastolic function: a correlation between phonomechanocardiography and echo-Doppler].

With the purpose to compare phonomechanocardiography and echo Doppler in the assessment of diastolic function of the left ventricle, we study 45 patients (30 male and 15 female) average age 50 +/- 9 years. We performed phonomechanocardiogram, echo-M, 2-D and Doppler transmitral. They were classified in four group according to mitral flow pattern: normal 14 patients; pattern I by Appleton (PI) 14 patients, 11 with aortic stenosis and 3 with hypertrophic cardiomyopathy; pattern II (PII) 12 patients with dilated cardiomyopathy grade III-IV and the last group of 5 patients with myocardial infarction with normal mitral flow but with impaired diastolic function by phonomechanocardiography. The phonomechanocardiographic index of ventricular relaxation (A2-O, ITRAT), compliance (a/D) and global diastolic function (ITAD) correlated with Doppler index (A2-D, E/A, atrial filling fraction, E-F slope and deceleration time) in N + PI group. The correlation was not significant when N + PI + PII or PI + PII groups were considered. The ITAD and E/A had r = 0.713 (p < 0.001) in N + PI, r = 0.12 (NS) in N + PI + PII and r = -0.308 (NS) in PI + PII. There was a dissociation between increased "a" wave in apexcardiogram and little "A" wave in PII patients suggesting "atrial failure". The patients with myocardial infarction received isosorbide dinitrate 5 mg showing changes of "pseudonormalizated" pattern in PI with normalized ITAD. This findings suggest that assessment of diastolic function by Doppler is dependent of loading conditions (specially preload), and cannot evaluate relaxation in PII but this is possible by phonomechanocardiography. It is advised the combination of the two technics for better assessment of diastolic function.

Adult↗

PubMed1989

Effects of intravenous metoprolol on global and regional left ventricular function after coronary arterial reperfusion in acute myocardial infarction.

Coronary reperfusion in myocardial infarction improves infarct zone motion, but its effect on the global ejection fraction has been less consistent. The directional movement of the ejection fraction is determined by the opposing influences of improved infarct zone motion and diminishing hyperkinesia in the noninfarct zone. Noninfarct zone hyperkinesia has been attributed to catecholamine stimulation, the Frank-Starling mechanism or intraventricular interactions that unload noninfarcted segments. To investigate the influence of catecholamine stimulation, 9 men presenting with a first myocardial infarction (mean age 53 +/- 13 years) were studied. Coronary reperfusion was accomplished less than 4 hours after the onset of myocardial infarction. Radionuclide ventriculography was then performed before and immediately after the intravenous administration of 15 mg of metoprolol. End-diastolic volume did not change, but end-systolic volume increased 28% after metoprolol (p = 0.041). The ejection fraction decreased from 55 +/- 13% before metoprolol to 45 +/- 14% after its administration (p = 0.002). There was no effect of intravenous metoprolol on infarct zone motion, whereas motion in the noninfarcted segment decreased (p = 0.002). The patients underwent repeat ventriculography after receiving metoprolol, 100 mg orally twice a day for 9 days. Infarct zone motion improved (p less than 0.002) and the ejection fraction increased to 55 +/- 12% (p less than 0.02). Normal zone motion did not change. Thus, compensatory hyperkinesia is at least in part caused by catecholamine stimulation. Conclusions regarding the effects of reperfusion on global ventricular performance can be influenced by the timing of ejection fraction determinations relative to metoprolol therapy.

Adult↗

PubMed2004

Validation of the Kidney Disease Quality of Life (KDQOL) cognitive function subscale.

BACKGROUND: Formal cognitive function testing is cumbersome, and no self-administered instruments for estimating cognitive function in persons with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been validated. The goal of this study was to determine the validity of the Kidney Disease Quality of Life Cognitive Function scale (KDQOL-CF) for the assessment of cognitive impairment in persons with kidney disease. METHODS: We administered the KDQOL-CF to 157 subjects, 79 with ESRD and 78 with CKD participating in a cross-sectional study of cognitive function. Scores on the Modified Mini-Mental State Exam (3MS) were considered the gold standard measure of global cognitive function. Performance characteristics of the KDQOL-CF were assessed using correlation coefficients, Bland-Altman plots, and receiver operating characteristic curves. RESULTS: Median scores on the KDQOL-CF were 73 (interquartile range 60-87) for subjects with ESRD and 87 (interquartile range 73-100) for subjects with CKD (P < 0.0001). Scores on the KDQOL-CF were directly correlated with scores on the 3MS (r = 0.31, P = 0.0001). Defining global cognitive impairment as a 3MS score < 80, a cut-point of 60 on the KDQOL-CF accurately classified 76% of subjects, with 52% sensitivity and 81% specificity. On multivariable analysis, cerebral and peripheral vascular disease, benzodiazepine use, and higher serum phosphorus concentrations were associated with lower KDQOL-CF scores, while beta blocker use, education, and higher serum albumin concentrations were associated with higher KDQOL-CF scores. CONCLUSION: The KDQOL-CF is a valid instrument for estimating cognitive function in patients with CKD and ESRD. KDQOL-CF screening followed by 3MS testing in selected individuals may prove to be an effective and efficient strategy for identifying cognitive impairment in patients with kidney disease.

Aged↗

PubMed2004

Decomposition of metabolic network into functional modules based on the global connectivity structure of reaction graph.

MOTIVATION: Metabolic networks are organized in a modular, hierarchical manner. Methods for a rational decomposition of the metabolic network into relatively independent functional subsets are essential to better understand the modularity and organization principle of a large-scale, genome-wide network. Network decomposition is also necessary for functional analysis of metabolism by pathway analysis methods that are often hampered by the problem of combinatorial explosion due to the complexity of metabolic network. Decomposition methods proposed in literature are mainly based on the connection degree of metabolites. To obtain a more reasonable decomposition, the global connectivity structure of metabolic networks should be taken into account. RESULTS: In this work, we use a reaction graph representation of a metabolic network for the identification of its global connectivity structure and for decomposition. A bow-tie connectivity structure similar to that previously discovered for metabolite graph is found also to exist in the reaction graph. Based on this bow-tie structure, a new decomposition method is proposed, which uses a distance definition derived from the path length between two reactions. An hierarchical classification tree is first constructed from the distance matrix among the reactions in the giant strong component of the bow-tie structure. These reactions are then grouped into different subsets based on the hierarchical tree. Reactions in the IN and OUT subsets of the bow-tie structure are subsequently placed in the corresponding subsets according to a 'majority rule'. Compared with the decomposition methods proposed in literature, ours is based on combined properties of the global network structure and local reaction connectivity rather than, primarily, on the connection degree of metabolites. The method is applied to decompose the metabolic network of Escherichia coli. Eleven subsets are obtained. More detailed investigations of the subsets show that reactions in the same subset are really functionally related. The rational decomposition of metabolic networks, and subsequent studies of the subsets, make it more amenable to understand the inherent organization and functionality of metabolic networks at the modular level. SUPPLEMENTARY INFORMATION: http://genome.gbf.de/bioinformatics/

Algorithms↗

PubMed1991

Effects of hydralazine and prostaglandin E1 on regional myocardial function in the ischemic canine heart.

The effects of hydralazine and prostaglandin E1 on regional myocardial function were studied in dogs. Sixteen dogs were randomly assigned to one of two drug treatment groups of eight dogs each. The first group (G1) was treated with 0.4 mg/kg hydralazine administered as a bolus. The second group (G2) received prostaglandin E1 given as an infusion for a total dose of 0.8 micrograms/kg. Regional myocardial function was assessed through the measurement of myocardial segment shortening during systole. We call this index percent systolic shortening (%SS). An ischemic heart preparation was created by partial occlusion of coronary blood flow. The degree of induced ischemia was determined by following the reduction in %SS. Hydralazine reduced %SS of the ischemic myocardium while increasing the cardiac index, stroke volume index, and coronary blood flow. Prostaglandin E1 increased %SS, cardiac index, and stroke volume index in the ischemic heart preparation. Hydralazine, therefore, induced dissociation between global ventricular function and regional myocardial function whereas prostaglandin E1 did not. The present findings emphasize that evaluation of vasoactive drugs should consider their effects on regional myocardial function as well as on global hemodynamics.

Alprostadil↗

PubMed2001

Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function.

BACKGROUND: Previous animal studies have demonstrated that the transmural extent of acute myocardial infarction defined by contrast-enhanced MRI (ceMRI) relates to early restoration of flow and future improvements in contractile function. We tested the hypothesis that ceMRI would have similar predictive value in humans. METHODS AND RESULTS: Twenty-four patients who presented with their first myocardial infarction and were successfully revascularized underwent cine and ceMRI of their heart within 7 days (scan 1) of the peak MB band of creatine kinase. Cine MRI was repeated 8 to 12 weeks later (scan 2). The transmural extent of infarction on scan 1 and wall thickening on both scans were determined using a 72-segment model. A total of 524 of 1571 segments (33%) were dysfunctional on scan 1. Improvement in segmental contractile function on scan 2 was inversely related to the transmural extent of infarction on scan 1 (P=0.001). Improvement in global contractile function, as assessed by ejection fraction and mean wall thickening score, was not predicted by peak creatine kinase-MB (P=0.66) or by total infarct size, as defined by MRI (P=0.70). The best predictor of global improvement was the extent of dysfunctional myocardium that was not infarcted or had infarction comprising <25% of left ventricular wall thickness (P<0.005 for ejection fraction, P<0.001 for mean wall thickening score). CONCLUSION: In patients with acute myocardial infarction, the transmural extent of infarction defined by ceMRI predicts improvement in contractile function.

Adult↗

PubMed2006

Percutaneous intracoronary delivery of SERCA gene increases myocardial function: a tissue Doppler imaging echocardiographic study.

The aim of this study was to examine the efficiency of adenovirus-mediated overexpression of sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA1a) gene in a realistic model based on percutaneous intracoronary delivery and on noninvasive functional monitoring. Catheter-based selective coronary delivery of saline or adenoviruses (Ad.CMV.SERCA1a or Ad.CMV.lacZ, 10(10) plaque-forming units) was performed in the circumflex artery of rabbits. Effects were assessed and compared by using serial Doppler echocardiography, hemodynamics, and measurements of SERCA protein and Ca(2+) uptake activity. On day 3, a 21% increase in SERCA proteins and a 37% increase in the maximal rate of Ca(2+) uptake were observed in the transfected left ventricular (LV) walls of Ad.CMV.SERCA1a rabbits. Baseline hemodynamics and conventional echographic measurements of global LV function were poorly affected. In contrast, tissue Doppler imaging (TDI) was able to assess a strong increase in the baseline function of transfected LV walls, as assessed with maximal wall velocities (+32% and +43%, respectively) and strain rates (+18% and +30%, respectively). TDI parameters were closely related to the maximal rate of Ca(2+) uptake (r(2) = 0.68 for the systolic strain rate). Serial TDI analysis during follow-up showed that the effects lasted for 7 days and were no longer detectable 15 days after adenoviruses injection. In conclusion, LV function can be increased by adenovirus-mediated overexpression of SERCA in a clinically relevant model, and TDI provides an accurate and noninvasive tool for monitoring effects on global as well as regional myocardial function.

Adenoviridae↗

PubMed1998

Evaluation of regional differences in right ventricular systolic function by acoustic quantification echocardiography and cine magnetic resonance imaging.

BACKGROUND: Accurate quantitative evaluation of right ventricular (RV) function has been limited by its complex structural geometry. Although embryological and anatomic observations suggest that the RV is composed of 2 distinct components, the RV sinus and infundibulum, most studies on RV dimensions and function viewed it as a single chamber. This study was designed to determine the volumes, relative contribution to global systolic function, and temporal course of contraction and relaxation of the RV sinus and infundibulum. METHODS AND RESULTS: Thirty-one individuals without heart disease (aged 1 month to 17 years, 16 boys and 15 girls) participated in this study. Instantaneous area over time, its derivatives, and the temporal course of contraction and relaxation were studied by acoustic quantification echocardiography and phonocardiography in 20 individuals. Global and regional RV volumes and ejection fraction were determined by cine MRI in 11 individuals. The RV sinus made up 81+/-6% of the combined RV end-diastolic volume and 87+/-4% of the combined stroke volume. The infundibulum accounted for the remaining 19+/-6% and 13+/-4%, respectively (P<0.0001). Compared with the infundibulum, the extent of RV sinus fiber shortening was significantly greater: for ejection fraction (56+/-11% versus 38+/-13%, P<0.001), fractional area change (42+/-14% versus 28+/-9%, P<0.0001), and dA/dt (27+/-17% versus 13+/-6%, P<0.0001). Analysis of temporal course of contraction and relaxation (expressed as percentage of the cardiac cycle to adjust for differences in heart rate) showed that the infundibulum follows the RV sinus: onset of contraction 53%+/-14 versus 19+/-11% of systole, time to peak systole 115+/-16% versus 97+/-19% (P< or =0.01), indicating a peristalsis-like pattern of contraction and relaxation. CONCLUSIONS: The results of this study demonstrate significant regional differences between the sinus and infundibulum components of the RV with regard to contribution to stroke volume, extent of fiber shortening, and sequence of mechanical activation. These data from normal individuals can be used in future research on RV function in pathological conditions.

Adolescent↗

PubMed2004

MR coronary angiography and late-enhancement myocardial MR in children who underwent arterial switch surgery for transposition of great arteries.

PURPOSE: To prospectively evaluate the feasibility of magnetic resonance (MR) coronary artery imaging and to define myocardial damage with late-enhancement myocardial MR imaging in children who underwent arterial switch surgery for transposition of the great arteries. MATERIALS AND METHODS: The local research ethics committee approved this study, and the subjects and/or a parent or guardian gave informed consent. Sixteen asymptomatic subjects who had undergone arterial switch surgery for transposition of the great arteries were studied (mean age, 10.8 years +/- 1.3; 11 male subjects, five female subjects). MR coronary angiography, late-enhancement MR imaging, global ventricular function, and regional wall motion were assessed. Fifteen children were awake during imaging; one was imaged with the use of general anesthetic. RESULTS: In 23 (72%) of 32 coronary arteries imaged, diagnostic-quality images of the coronary ostium and proximal coronary artery course were acquired; this increased to 100% in subjects older than 11 years. No coronary ostial stenoses were seen. In all subjects, the proximal course of the coronary arteries was visualized. Two subendocardial viability defects were detected, which corresponded to known compromise of the artery that supplied that territory at the time of surgery. Global left and right ventricular function were preserved, with no regional wall abnormalities. CONCLUSION: Diagnostic-quality MR coronary angiography is feasible in subjects who have undergone arterial switch surgery for transposition of the great arteries, with no unexpected areas of myocardial infarction detected.

Adolescent↗

PubMed2001

TBP-interacting protein TIP120A is a new global transcription activator with bipartite functional domains.

BACKGROUND: We previously identified a TBP (TATA-binding protein)-interacting protein 120A (TIP120A) from rat liver nuclear extracts. TIP120A is thought to be a unique global transcription factor that can interact with TBP and can stimulate all classes of eukaryotic transcription. RESULTS: We produced various truncation proteins of TIP120A to delineate its functional domains. TIP120A binds to TBP in the acidic amino acid-rich N-terminal region and in the leucine-rich C-terminal region. These regions exhibited an ability to stimulate basal transcription in vitro. In addition, these two regions overlap with domains that facilitate nonspecific DNA-binding of RNA polymerase II. The sequences of these two regions are significantly conserved among TIP120A homologues of eukaryotes. CONCLUSIONS: TIP120A is a bipartite transcription factor, and both N-terminal and C-terminal regions exhibit TBP-binding activity and stimulate the basal transcription ability.

Amino Acid Sequence↗

PubMed1986

Right and left ventricular performance in acute hypoxemic respiratory failure.

We examined biventricular performance on two occasions in 28 patients with acute hypoxemic respiratory failure (ARF), using a combination of invasively determined pressures and flows as well as radionuclide scintigraphy to measure the right and left ventricular ejection fractions (RVEF and LVEF, respectively). From the EF and concurrently measured thermodilution stroke volumes, we calculated right and left ventricular end-diastolic and end-systolic volume indices (EDVI and ESVI, respectively). Regression analysis demonstrated that changes (delta) in global right ventricular function (RVEF) were inversely correlated with concurrent changes in the mean pulmonary arterial pressure (MPAP): delta RVEF = 0.015-0.015 delta MPAP (r2 = 0.60; p less than .005), while an increase in right ventricular preload (RVEDVI) was positively correlated with changes in MPAP: delta RVEDVI = 2.68 +/- 6.27 delta MPAP (r2 = 0.46; p less than .005). Global left ventricular function (LVEF) was related to changes in systemic pressures as well as to right-sided events: delta LVEF = -0.01-0.0015(delta RVESVI) + 0.001(delta BP systolic)-0.42(CVP/RVEDVI) (r2 = 0.35; p less than .01). These data confirm the significant influence of right ventricular afterload on RVEF in ARF patients and an apparent interrelationship between altered right ventricular systolic function and global left ventricular performance.

Acute Disease↗

PubMed1986

Coronary artery bypass surgery in patients with left ventricular dysfunction.

The effects of coronary artery bypass surgery in patients with left ventricular dysfunction (left ventricular ejection fraction of less than 45 percent) on survival, symptoms, left ventricular ejection fraction, and regional left ventricular function were prospectively assessed in 34 patients. Left ventricular function was serially assessed by nuclear angiocardiography. Operative mortality was 9 percent, and mortality during the follow-up period was 10 percent. Twenty of 21 patients with class III or IV anginal symptoms preoperatively improved by at least two functional classes. Seven of 10 patients with class III or IV symptoms of heart failure preoperatively improved by at least one functional class. Global left ventricular ejection fraction improved significantly with surgery (p less than 0.05). Regional left ventricular systolic function improved as well (p less than 0.005). These findings suggest that in selected patients with left ventricular dysfunction, coronary artery bypass surgery can be performed with acceptable mortality and may result in symptomatic and functional benefit.

Adult↗

PubMed1996

Assessment of left ventricular function and hemodynamics with transesophageal echocardiography.

Transesophageal echocardiography (TEE) plays an important role in the evaluation of left ventricular function and hemodynamics in the critical care setting. The technique provides immediate data regarding regional myocardial ischemia, global ventricular function, volume, and the presence of cardiac tamponade. This article outlines the role of TEE in the evaluation of left ventricular function in the intensive care unit and presents practical information for the use of TEE in evaluating systolic function, diastolic function, and cardiac tamponade.

Cardiac Output↗

PubMed2006

Differential impact of executive function on visual memory tasks.

Despite their common use in neuropsychological evaluation, little is known about the differential contribution of executive functioning to visual memory tests. In this study, hierarchical regression was used to determine the role of executive functioning on the Visual Reproduction subtest of the Wechsler Memory Scale--Third Edition, and the Rey-Osterrieth Complex Figure (ROCF) in a mixed neurological sample of 193 patients. Executive functioning was predictive of Visual Reproduction but not ROCF recall variables after accounting for demographic variables and global cognitive functioning. Only executive tests with a visuospatial component, the Trail-Making Test Part B and Wisconsin Card Sorting Test perseverative responses, were predictive of recall of Visual Reproduction stimuli. Organization of the ROCF was predictive of both Visual Reproduction and ROCF recall. These findings increase our understanding of the executive contribution to two common visual memory tests and may aid in the clinical interpretation of seemingly discrepant visual memory performance.

Adult↗

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